USE OF HANCOCK PORCINE XENOGRAFTS IN CHILDREN AND ADOLESCENTS
USE OF HANCOCK PORCINE XENOGRAFTS IN CHILDREN AND ADOLESCENTS
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DOI：
10.1016/0002-9149(80)90012-0
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发表时间：
1980-01-01
影响因子：
2.8
通讯作者：
CASTANEDA, AR
中科院分区：
文献类型：
--
作者：
SANDERS, SP;LEVY, RJ;CASTANEDA, AR
自1974年1月1日至1978年12月31日，对44例患者施行了47枚异种移植物（主动脉瓣8枚，二尖瓣28枚，三尖瓣4枚，I型大动脉转位左房室瓣3枚，二尖瓣-二尖瓣混合瓣3枚），年龄10/12 ~ 20 5/12岁（中位年龄12 2/12）。8例主动脉瓣置换术患者均存活，随访22.5 ± 10.4个月（平均值±平均值的标准误）。3例患者术后心导管检查时，收缩期射血压差峰值范围为24 - 38 mm Hg，瓣膜面积指数为0.71 - 1.15 cm 2/m2。二尖瓣置换术26例，手术死亡5例，术后2个月死亡2例，长期存活19例，随访26.2 ± 15.6个月。在11例接受术后心导管检查的患者中，平均舒张压差为6.1 ± 2.7 mm Hg，平均瓣膜指数为1.79 ± 0.76 cm 2/m2。严重的主动脉瓣下梗阻，由于人工二尖瓣，发生在5岁以下的5例患者中的3例。在接受三尖瓣置换术的4例患者中，没有手术死亡，3例发生完全性心脏传导阻滞。2例患者术后插管时，平均舒张压差分别为3和5 mm Hg，瓣膜指数分别为1.32和1.7 cm 2/m2。对3例I型大动脉转位患者行体循环房室瓣置换术，随访12 ~ 37个月。术后导管插入时，平均舒张压差为0 - 4 mm Hg，瓣膜指数范围为1.68 - 1.88 cm 2/m2。3例患儿同时行主动脉瓣和二尖瓣置换术。1例手术死亡，1例术后6个月死亡。幸存者有完全性心脏传导阻滞，但属于纽约心脏协会功能I级。8个异种移植物（6个二尖瓣，1个I型大动脉转位的左房室瓣和1个主动脉瓣）失败，需要在植入后22至68个月进行置换。所有患者均有不同程度的钙化。瓣膜失效在植入后22个月开始出现，在植入20个月或更长时间的25个瓣膜中，8个已经更换。这8例患者初次瓣膜置换时年龄（10.3 ± 0.2岁）比其他17例随访20个月或更长时间的患者年龄（15.0 ± 0.3岁）小（p <0.05）。在分析的所有6个钙化异种移植物中均发现高水平的γ-羧基谷氨酸（GLA）（一种钙结合氨基酸），而在新鲜猪主动脉瓣或未植入的异种移植物中均未发现。含GLA的蛋白质，在植入后沉积，可能在异种移植物钙化中起作用。
Between January 1,1974 and December 31,1978,47 xenografts (8 aortic, 28 mitral, 4 tricuspid, 3 left atrioventricular valve in I-transposition of the great arteries and 3 aortic-mitral) were implanted in 44 patients, aged 10/12 to 20 5/12 years (median 12 2/12). All eight patients with aortic valve replacement survived and were followed up for 22.5 ± 10.4 months (mean ± standard error of the mean). At postoperative cardiac catheterization in three patients, the peak systolic ejection gradient ranged between 24 and 38 mm Hg and the valve area index between 0.71 and 1.15 cm2/m2. Among 26 patients who underwent mitral valve replacement, 5 died operatively and 2 died 2 months postoperatively, leaving 19 long-term survivors who were followed up for 26.2 ± 15.6 months. In the 11 patients who underwent postoperative cardiac catheterization, the mean diastolic gradient was 6.1 ± 2.7 mm Hg and the mean valve index 1.79 ± 0.76 cm2/m2. Severe subaortic obstruction, due to the prosthetic mitral valve, occurred in three of five patients less than 5 years old.Among four patients who underwent tricuspid valve replacement there were no operative deaths; complete heart block occurred in three. At postoperative catheterization in two patients, the mean diastolic gradient was 3 and 5 mm Hg, and the valve index 1.32 and 1.7 cm2/m2, respectively. Three patients with I-transposition of the great arteries who underwent replacement of the systemic atrioventricular valve were followed up for 12 to 37 months. At postoperative catheterization the mean diastolic gradient was 0 to 4 mm Hg and the valve index ranged from 1.68 to 1.88 cm2/m2. Both aortic and mitral valves were replaced in three children. One died at operation and one 6 months after operation. The survivor has complete heart block but is in New York Heart Association functional class I.Eight xenografts (6 mitral, 1 left atrioventricular valve in I-transposition of the great arteries and 1 aortic) failed, requiring replacement 22 to 68 months after implantation. All were calcified to varying degrees. Valve failure began presenting 22 months after implantation, and of 25 valves implanted for 20 months or longer, 8 have been replaced. These 8 patients were younger (10.3 ± 0.2 years) at initial valve replacement than the other 17 patients (15.0 ± 0.3 years) followed up for 20 months or longer (p <0.05). High levels of γ-carboxyglutamic acid (GLA), a calciumbinding amino acid, were found in all six calcified xenografts analyzed, whereas none was found in a fresh porcine aortic valve or in an unimplanted xenograft. GLA-containing protein, laid down after implantation, may play a role in xenograft calcification.